374604318-3-12-2024-08-AS-JLOT-D6NHNE-20240628062035

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604318
Report Date: 03/12/2024
Date Signed: 03/12/2024 12:57:43 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/05/2024 and conducted by Evaluator Nacole Patterson

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20240205151341

FACILITY NAME:	WESTMONT OF ENCINITAS		FACILITY NUMBER:	374604318
ADMINISTRATOR:	NEWTON, RANDAL		FACILITY TYPE:	740
ADDRESS:	1920 SOUTH EL CAMINO REAL		TELEPHONE:	(760) 452-6037
CITY:	ENCINITAS	STATE: CA	ZIP CODE:	92024
CAPACITY:	101	CENSUS: 80	DATE:	03/12/2024
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Business Office Director Angie De Asis, Senior Regional VP of Operations Steven Harms		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Licensee did not address resident's change in condition.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPA introduced herself and disclosed the purpose of the visit to Business Office Director Angie De Asis. During the visit Senior Regional VP of Operations Steven Harms was present at the facility and met with LPA.

On 2/5/24 it was alleged that the Licensee did not address a change in condition for resident 1 (R1), resulting in numerous falls. The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, residents, outside sources, and records review. Staff interview revealed that upon observing the increase in weakness and falls, the Licensee updated R1's care plan to level 6 to reflect the need for stand-by assistance for all activities of daily living (ADLs). Staff interview, corroborated by facility and outside source records, revealed that staff contacted the family for each of R1's falls, communicated with the POA regarding R1's change in condition, and remained in contact with the family throughout R1 being admitted into Hospice. (Continued on LIC9099-C p.2)

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 08-AS-20240205151341

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: WESTMONT OF ENCINITAS	FACILITY NUMBER: 374604318
	VISIT DATE: 03/12/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(Continued from LIC9099 p.1)

Outside source interviews corroborated staff statements that paramedics responded to the facility numerous times due to R1's falls, and that R1 frequently refused to be transported to the hospital. Outside sources informed that R1's family and Responsible Party were notified regarding the falls, and were involved in the conversation regarding R1 needing an increased level of care.

Facility and outside source records review revealed that R1 suffered multiple falls due to attempting to ambulate on their own, even after staff reminded them to use their pendant to call for help before trying to walk. Facility incident reports, email communication, and progress notes showed that the Licensee was monitoring R1's change in condition, reassessed R1, and communicated the changes to the Responsible Party. Records review further showed that R1 was placed on Hospice per the family's request, and the Licensee assisted with the transition into Hospice care.

Interview with R1 was not possible, due to their passing away.

Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Senior Regional VP of Operations Steven Harms, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2